Can Gallstones and Fatty Liver Cause Chest and Shoulder Pain?

Can gallstones and fatty liver cause pain in the epigastric region or upper abdomen, right shoulder pain, and discomfort in the back?

Hello, Director Chen.
I apologize for interrupting you during your busy schedule.
I am 36 years old, have never smoked or consumed alcohol, and my blood tests show no signs of metabolic syndrome (blood pressure around 125 or below, normal high/low-density lipoprotein cholesterol, normal cardiac enzymes, and glycated hemoglobin = 5).
I would like to ask you if gallstones and fatty liver can cause upper abdominal pain.
Two years ago (in 2014), during a health check-up, an abdominal ultrasound revealed two gallstones (one measuring 1.1 cm and the other 1.3 cm; I am unsure if these sizes are considered large or small), and I was diagnosed with moderate to severe fatty liver (without hepatitis, and liver function tests were normal).
My total bilirubin was slightly elevated but returned to normal upon retesting two weeks later.
Additionally, during an endoscopy and colonoscopy, gastroesophageal reflux was not found, but there was mild superficial gastritis.

Over the past year, I have experienced discomfort in the "chest area" (approximately at the xiphoid process; I am unsure if this is considered "chest" or "upper abdomen").
The discomfort feels like "sharp pain, pressure pain, and cramping," and it seems to be visceral pain rather than muscular pain.
I also have associated "right shoulder pain" (localized pain that can be precisely pointed out, with a sharp sensation resembling nerve pain rather than muscle pain) and "right upper back pain" (a dull ache, similar to a nagging pain).
However, the pain in these areas rarely lasts more than one minute before subsiding, only to reoccur later.
I have not yet identified any patterns for these occurrences, but they are uncomfortable and concerning.

I have visited a cardiologist (exercise electrocardiogram + myocardial perfusion, with no signs of hypoxia) and a pulmonologist (self-paid 256-slice CT scan, with no abnormalities).
Therefore, I would like to ask if "gallstones" and "fatty liver" could lead to the various physical discomfort symptoms I am experiencing (including "sharp pain and pressure sensation at the xiphoid process," "localized sharp pain in the right shoulder," and "dull nagging pain in the right upper back").
I would greatly appreciate your clarification on this matter.
Thank you very much.
Sincerely, Mr.
Chen.

Mr. Chen, 30~39 year old female. Ask Date: 2016/10/17

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
While the chances of related opportunities may not be significant, if you have been troubled for a long time, you might consider laparoscopic cholecystectomy to prevent future occurrences of gallstones.
Changhua Hospital cares about your health.
Sincerely, Chen Shidian.

Reply Date: 2016/10/17

More Info

Gallstones and fatty liver disease can indeed contribute to various abdominal and referred pain symptoms, including discomfort in the chest and shoulder areas. However, the relationship between these conditions and the specific symptoms you are experiencing can be complex.

Gallstones, particularly when they obstruct the bile ducts or cause inflammation of the gallbladder (cholecystitis), can lead to significant pain. This pain is typically located in the right upper quadrant of the abdomen and can radiate to the back and right shoulder due to shared nerve pathways. The pain is often described as sharp, cramping, or a feeling of pressure, particularly after consuming fatty or greasy foods. In your case, the presence of gallstones (1.1 cm and 1.3 cm in size) could potentially be the source of your upper abdominal discomfort, especially if they are causing intermittent obstruction or irritation.

Fatty liver disease, on the other hand, is generally asymptomatic in its early stages. However, as the condition progresses, it can lead to inflammation (steatohepatitis) and potentially liver damage, which might manifest as discomfort in the upper abdomen. While fatty liver itself is less likely to cause acute pain, it can contribute to a general feeling of malaise or discomfort in the abdominal region.

The specific symptoms you describe—sharp pain in the epigastric area (around the "xiphoid process"), right shoulder pain, and upper back discomfort—could be indicative of a few different issues. The epigastric pain may be related to gallbladder irritation or even gastritis, especially since you mentioned having superficial gastritis in the past. The right shoulder pain, particularly if it is sharp and pinpointed, could be a referred pain from the gallbladder or even a musculoskeletal issue. The upper back pain may also be related to referred pain from the gallbladder or could be due to tension or strain in the back muscles.

It's important to note that while gallstones can cause significant pain, not all individuals with gallstones experience symptoms. The fact that your pain episodes are brief and self-resolving could suggest that they are not due to acute gallbladder attacks but rather intermittent irritation. However, given your history and the presence of gallstones, it would be prudent to monitor these symptoms closely.

Since you have already undergone evaluations by cardiology and pulmonology, and no significant abnormalities were found, it may be beneficial to consult with a gastroenterologist for further assessment. They may recommend additional imaging studies or even consider the possibility of laparoscopic cholecystectomy (gallbladder removal) if they determine that your symptoms are indeed related to the gallstones.

In summary, while gallstones and fatty liver can contribute to abdominal discomfort and referred pain, the specific nature of your symptoms warrants further investigation. It is essential to work closely with your healthcare provider to determine the underlying cause of your discomfort and to develop an appropriate management plan.

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